.

>> Good evening.

I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th year matters the Mind is a live Call-In program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues ,give me a call in the Fort Wayne area by dialing (969) 27 two zero or if you're calling coast to coast you toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis we are broadcast live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you'd like to contact me with an e-mail question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at www org that's matters of the mind at WFA Doug and I'll start tonight's program with an email I received this past week.

>> It reads Dear Dear Father, how can in a city also known as in Acetylcysteine be therapeutic for psychiatric conditions such as ADHD anxiety and depression?

>> Well, in a C is a sulpher is a sulfur derivative and if you have a sulfur allergy you shouldn't you shouldn't take any but any C is an interesting product because it is a supplement that can be helpful for the conditions in which you mentioned ADHD depression and anxiety should everybody take it depends but 600 milligrams twice a day is the usual dosage.

Most people tolerate it quite nicely.

Here's what it does.

It basically cleans up the mess around neurons each of your individual neurons in the gray matter of your brain which the outside part of your brain have eight to ten of these little glial cells around them.

>> The glial cells are like the pit crew at NASCAR or Indy car.

All right.

So imagine having a pit crew around your individual neurons eight to ten pit crew and they clean up the mess.

>> So if you watch NASCAR or Indy car racing you'll see that the pit crew was cleaning up tires and they're taking care of things.

Imagine if that pit crew was not working together.

Imagine if that pit crew wasn't working efficiently.

But what will happen is you'll have a slower pit stop and that'll lose the race for you.

So what you want is a very efficient pit crew that not only nourishes the car or in this case the neurons themselves but actually cleans up the mess.

>> What it will do is clean up the mess around the neurons.

What happens these glial cells which are the pit crew sometimes get a little sickly especially as we get older and especially as people are going through a lot of stress if you're going through really tough stuff day by day, your little glial cells get more sickly so your pit crew taking care of your neurons and nourishing the neurons and cleaning things up around the neurons they get more sickly and that makes things not work so well and actually your neurons start to shrivel up because of that.

>> So what a will do is help get the junk out of around the outside of the neuron by increasing the vacuuming ability of the actual pit crew the glial cells so cleans up the mess.

So bottom line is when people take in a C they'll notice many times that they will have a bit less anxiety.

It won't help everybody but sure is worth a try and I'm always encouraging people to ask their clinicians what supplements.

Here's they might take.

So if you ask your clinician want supplement he or she takes I think clinicians should be forthcoming and tell people and I take and I see myself so in AC 600 milligrams twice a day is a commonly recommended adjunctive treatment for anxiety, depression, focus ,concentration but it's something that is an extra expense so you have to balance that out with your prescription medications.

Obviously insurance will not cover next to be paying out of pocket but it is an over-the-counter product that typically is really well tolerated.

Occasionally people will have a little bit of nausea if they get too much in AC but generally it's very well tolerated can be taken with or without food.

Morning and evening.

Morning evening is how you typically take it.

>> Thank you for email.

Let's go to our first caller for tonight.

Hello Brenno.

Welcome to Matters of Mind.

>> Brenda, you want to know about Rizzolatti?

What is it and why would somebody need to add to their depression medication result is Breck's Pip Resul it's the chemical cousin to European Resul which is Abilify which has been around for a long time.

Abilify and Rik's Zolt are added onto existing antidepressant medication sometimes make them work a little bit better.

It's kind of like adding extra seasoning to an antidepressant medication.

Exalted Brazil is particularly good at helping people with post-traumatic stress symptoms as well either by itself or with an antidepressant medication.

What it will do is fine tune the serotonin and norepinephrine and dopamine functioning and it's kind of like a means of helping the depression treatment along a little bit better and result is particularly good for people who have a sense of feeling wired and revved up but yet they're tired.

It sounds like a strange type of symptom complex but some people feel kind of revved up and anxious but at the same time they're exhausted results particularly good for helping those kind of people, those kind of symptoms for those people.

So result is commonly added on at a very low dose.

Each is also used for schizophrenia and bipolar disorder but it can be used as an add on medication for a lot of people who are not getting adequate relief from their existing antidepressant medication.

>> Brianna, thanks for your call.

Let's go our next caller.

Hello, Charlotte.

Welcome.

The mastermind Charlotte.

>> You want to know how important it is for someone who has postpartum depression not to isolate themselves?

That's very important that the not isolate themselves.

Charlotte, I talked to a lady just this afternoon who is experiencing postpartum depression and we're talking about this phenomenon.

So postpartum depression is a situation where within a year of your delivery, particularly the first three months after a delivery woman can get unnaturally depressed day by day, she'll notice that she can't take care of her baby not uncommonly socialization, difficulty concentration, fatigue are particularly problematic.

It happens in as many as 10 percent of women after they deliver a baby.

Postpartum psychosis is a different phenomenon that occurs in just a small number of people.

But that's where women actually get psychotic and they lose touch with reality.

Now when somebody has postpartum depression Sarlat Shilat I want them to not isolate themselves because if you withdraw from people around you it's actually a precursor and a predictor for getting more depressed.

That's the case for all of us.

So we all need to stay engaged with people.

It's a natural type of expectation that we all will experience so we need to be around people and if you socially withdrawal that would be problematic for you.

So being around family, friends, getting out every now and then can be very, very helpful.

>> Sheila, thanks for your call.

Let's go next.

>> Hello Fred.

Welcome to Of Mind.

Thank you sir.

You are so good.

>> Thank you for that.

I ordered your book Man's Search for Meaning you did Frankel that's not my book.

>> Yes.

Thank you.

Thank you for not making me the author on that Fred because no, no, no.

Victor Frankl is a brilliant psychiatrist who was doing a lot of work back in the 1930s and 1940s but you've not read it yet?

>> Well, I read it and I was a refugee caseworker for twenty nine different nations as well bringing them to Fort Wayne .

Wow.

And it's such a broad based approach to humanity because I read it from many countries, many religions, many cultures it is it's really a good base.

>> Yeah.

For social work reading it is Fred because somebody asked me a few weeks ago you must have been watching that episode if I could recommend one book for people outside the Bible what would I recommend for them?

And that's what I recommend a man's search for reading by Victor Frankl that was written back in the nineteen late 1940s after he got out of the concentration camp and he was going head to head with Sigmund Freud and Carl Jung back in the 1930s because they had these different techniques.

He basically said when a person has trouble with depression and anxiety basically it's related to their not having meaning in their lives and we've known all along that that lack of meaning is a predictor for suicide.

>> Well, it is tremendously applicable to people who find themselves in a country they don't know about and it's just so applicable to that type of approach and everything else.

Yeah, I heard that that night and I ordered they called the use of Dukan and it has a lot of extra articles in it.

>> Yeah.

Victor Frankel's grandson has taken up his work and is still expanding that but called logo therapy where basically it's a therapy where as you're talking to somebody you're trying to find out what's really important for them, what they can look forward to.

And Fred, a big area of research in psychiatry right now and something we're always examining will be the whole concept of anhedonia.

>> There is the consumption tau and come sumptuary anhedonia where you can't enjoy things like a chocolate cake or you can enjoy a concert, you just can't enjoy things at all and then you have the anticipate it and anhedonia where you don't you don't think about enjoying things in the future.

So this whole concept of anhedonia gives us meaning because it allows us to look forward to something and that's kind of the basis behind loga therapy that Viktor Frankl was talking about that that's featured in the book and I really enjoyed it.

>> Didn't you enjoy his his actually going through the details of his experience in the concentration camp?

>> Yes.

Well it mirrored so many things .

Many, many refugees come with little or no hope.

Yeah.

Or knowledge and then you try to say you could do this maybe think about it but the best was when they would come with an idea just out of the blue.

Yeah.

And and be brave enough to go after it it it was it was fulfilling yeah.

>> I'm sure it wasn't lost on you but Dr. Frankel mentioned that in the concentration camp the people who lost meaning and purpose to their lives those are the ones who died the people who yes.

Had anything to look forward to kept going on and I think that's so indicative of what we all go through in life read well it's everybody you know, so many so many negative things among refugee experiences.

Yeah.

And so much hope built watching other people succeed.

Yeah, it was wonderful.

Thank well thank you so much for your work Fred with the refugees.

>> Have a good evening.

>> Let's go our next caller.

Hello Matthew.

Welcome to mind.

Hi Dr. Fauver this is Matthew Krieble.

Hi Matthew.

I got a question.

I got sugar diabetes type two and I wanted to know about Matt Foreman.

I take for my with other segments I take and cannot lower your agency or yeah.

>> Matthew, thanks for your call.

Metformin is a medication has been around for decades.

It used to be called Glucophage as a brand name medication metformin is a four dollars a month medication for a lot of people nowadays.

So it's very affordable and it's very effective especially for people who were taken in antipsychotic medication like LA to a LA resident.

>> It's a medication that will basically decrease the absorption of glucose in your gut and then a decrease the production of glucose in your liver.

>> So in other words it makes insulin a little bit more sensitized.

>> So it's a very well tolerated medication for a lot of people if it gives you any nausea, many people take the long the controlled acting formulation which would be a thousand milligrams and the controlled release tablet every day people typically will go to a thousand two thousand milligrams is not uncommon as well but the higher doses sometimes give people diarrhea and that can be problematic for some people and that's where they can split up the dosage some but metformin is a very inexpensive, safe and very effective medication in terms of decreasing likelihood of developing Type two diabetes.

And if you have Type two diabetes, you bet Matthew it can decrease your agency which is basically a measure of your average glucoses for the past 90 days, a one it looks at a little a little chemical component in your blood cells and holds on to glucose and it does so over the course of ninety days and a see basically as a measure of how much it does that.

So the higher they can see the more glucose you've had on an average basis.

But metformin is a very well recommended medication for anybody who is on an anti psychotic medication if they have a diagnosis of schizophrenia, bipolar disorder, those diagnoses in themselves will put you at higher risk for glucose disturbances because if you have a psychiatric condition such as those, they can cause you to have difficulties with cortisol metabolism and thereby give you difficulty glucose itself.

>> Matthew, thanks for your call.

Let's go to our next e-mail question.

Our next email reads Dear Dr.

Favor, how do traumatic experiences affect memory and can they alter untreated memory?

>> Can you alter untreated memories over time?

How do people heal from trauma basically earlier in your life where you've experienced trauma the more impactful it can be your brain long term and the general rule of thumb is if you've experienced trauma before the age of eight years old trauma be an emotional abuse, sexual abuse, physical abuse.

Your parents got divorced.

Somebody in the family were drinking alcohol, something in the family got jailed, some kind of significant trauma as a young child that can have significant effects on the brain but it's not necessarily permanent effects on the brain.

But if somebody had a lot of trauma prior to the age of eight years old, for instance, they're less likely to respond later on in life to a serotonin based antidepressant medication and it's a predictor for an antidepressant medication of a certain class not to work that classes the so-called selective serotonin reuptake inhibitors.

So if you had a lot of early childhood trauma, you're not as likely compared to other medications to respond to Prozac, Paxil, Zoloft, Celexa, Lexapro, Luvox.

These are medications used for depression very commonly.

But a predictor for those medications not to work will be especially early childhood trauma.

Now why does that happen in your early childhood?

Your brain is developing.

It's growing in some areas.

It's shrinking in other areas now it's good for some of our neurons to kind of shrivel up.

We call it apoptosis.

That's where they are basically getting pruned.

So if you have a tree out in your yard it's good for a healthy tree, especially a fruit tree for instance, to prune it down a little bit and take off the dead branches or the branches that are really useful because it makes the tree more healthy.

>> Rose bushes good example there are two the more you selectively prune rose bushes you'll get more beautiful blossoms coming out.

You want to prune your trees in the same way your brain naturally will prune itself.

>> The concept is called neuroplastic City where you'll have some of the brain getting more fluffy, others getting prude.

Now a healthy brain will know how to prune off the area that is causing you traumatic memories.

Now you can actually get rid of some of the traumatic memories in various ways there are treatments such as eye movement desensitization and reprocessing that will focus on specific ways of dealing with traumatic memories.

>> But if you had early childhood traumatic memories from a medication standpoint we're going to be very careful on what medication we might be able to utilize.

But yes, you can recover from past trauma and various ways.

But from a biological standpoint of the brain, what you're trying to do is get more pruning of the bad memories and get rid of those branches that are causing that as you continue to ruminate and focus on the bad memories, it's thought that you can actually cause more branching of the neurons that are responsible for the bad memories.

>> That's not a good thing.

So we try to get people to divert the attention to thinking more well to put it quite simply happy thoughts and more constructive thoughts to try to delegitimize the bad memories you had from the past.

So it's an interesting phenomenon that occurs but you can recover from past trauma by various treatment strategies.

One of the treatment strategies very practical will it will be to have some kind of purpose and meaning that gives you a drive for looking forward to the future.

So we will often have people involved in focusing on their purpose and meaning in life .

Fred talked earlier about Victor Frankel's book Man's Search for Meaning that his basically focused on that whole treatment strategy itself and it's a very good way of dealing with trauma, finding a purpose, finding meaning, having something to look forward to on a day to day basis.

>> Thanks for your call.

Let's go our next caller.

Hello Mary.

Welcome to the Mind.

>> Hello.

Hello Mary.

I can hear you loudly and clearly.

Yes, I have been having auditory hallucinations as in music OK since April of last year and I am currently on two medications when is motor genes and the other thing whereas adone and my psychiatrist has tried to change one of those to a more effective medication hopefully for that those hallucinations but insurance hasn't covered either of them about exorbitant cost.

You have suggestions on the type of therapy.

>> Anything else that I could try?

I'm curious, Mary, what's the nature of your auditory hallucinations?

>> You mentioned they started about a year and a half ago in the involved music actually a year ago April and Eighties music it can be free music that are just repetitive and or three notes in their own.

It's very odd if I don't have something musical to avert those limited notes or phrases then they just repetitively go on and my mind is the music is the music involving musical notes or is it a song where you can actually hear the lyrics hits the musical notes just notes not no words no OK and I hate to ask a woman for her age but Mary getting within a decade what how old were you when they started to oh my goodness no no no I am sixty two and it started a month before my birthday in May.

Well twenty four now or have you seen a neurologist.

No strictly seeing my psychiatrist.

>> OK and how were you doing before this past year or so from a mental health standpoint did you have any depression, anxiety, any problems to speak of on a day to day had a delusional episode three in one day and so I was hospitalized but since that point I have not and that was December of twenty three.

>> OK, well let's go back even further.

How are you doing before twenty twenty bipolar PTSD anxiety sleep disorder.

>> OK so yeah you had a few things going on prior to twenty twenty with your mood there was already there correct.

>> OK did you covid know you never had a covert infection.

No fantastic.

I did hear about people having strange neurological type of symptoms happening after a Koven infection so we don't have to worry about that for you.

>> Yeah I think Lamotrigine is a very good medication for you because what you're describing is kind like a neurological phenomenon.

Llamosa Lamictal is often used for mood stabilization but we'll use it for these oh kind of odd neurological symptoms.

Now you're describing a type of auditory hallucinations that we would call an elementary auditory hallucination in other words is not first degree, it's not second degree.

Those kind of auditory hallucinations involve voices either talking outside your head, inside your head you're describing your music and it can be annoying but it's not considered to be as as pathological as other conditions.

Now will your insurance cover medications as you'd mentioned Loredo which is La Tuta will cover those type of thing.

>> I like the idea that your psychiatrist is trying the less the less toxic type of medications for you and let tutelary Sadoun is one of them.

You know there are newer medications coming out but I think a kind of medication that would give you a little bit that antipsychotic effect could be helpful.

>> But I'm wondering you're talking about elementary hallucinations and these aren't the first and second order hallucinations which tells me maybe an antipsychotic medication wouldn't be what you actually need anyway.

>> Perhaps something along the lines of something that would block excessive glutamate.

On one hand Lamotrigine does decrease the firing of glutamate but glutamate is the excitatory chemical in the brain.

>> When you hear music, especially when you're singing you're going to be using this right front part of your brain.

So the musical network is different from the voice network and that's why it's important to understand that these are elementary hallucinations involving music and they're not first and second order hallucinations involving people's voices.

>> So with that being said, you might want to consider treatment or talk to this about your with your psychiatrist about the possibility of a medication that would block with block glutamate.

>> Now had you ever taken a medication even at low doses called Depakote that would ring a bell?

>> No, have never taken that Depakote.

I don't want you to take tiny doses of it.

Depakote actually decreases and blocks glutamate and you can use it on top of Lamotrigine and they work in tandem that way.

But if you have excessive excitatory glutamate in your brain, your brain will fire unnaturally and it's kind of like having a seizure in that sense.

>> But you're having a seizure of music so to speak.

>> Now there's a phenomenon that's really annoying to some people it's called an earworm where they just hear a song going over and over in their heads and they do the same thing you will do to cope with that.

They will listen to music or they'll try to do something to distract themselves and that's one technique.

But if you're really trying to biologies quickly take care of this music that is distinctly audible and it's really annoying.

That's why I wonder if you could go a different direction.

You could try the antipsychotic medications that basically blocked dopamine.

But I think maybe it's a condition from a neurological standpoint if it just came on when you're at the young age of sixty one 62 years old, if it just came on it might have been a slight neurological development that could be maybe mitigated by something that blocks glutamate.

>> So maybe going with a second medication on top of Lamotrigine gene that would do that Depakote what are those medications?

And it's very, very inexpensive so that would be something would be affordable.

>> Mary, keep in contact with your psychiatrist because that should be a treatable condition for you.

>> Thank you.

OK, take care Mary.

Thanks for calling.

Let's go to our last caller.

Hello Greg.

Welcome to Mastermind Greg.

>> You want to know how important is it to take breaks for your mental health in a high stress job?

The best thing you can do if you can do it, Craig, is take about a 20 minute nap late afternoon.

I recommend this to medical students.

I recommend to a lot of people who are thinking, thinking, thinking all day long and they're in a high stress job this left front part of your brain which is called the dorsolateral prefrontal cortex works really hard when you're thinking, thinking, thinking your really focusing on things and that's why your brain kind of feels tired when you've been on the high stress job for for a long time.

If you take a 20 minute 30 minute nap, what you do is you basically just refresh this part of the brain and it's kind of like just racing your inbox and just allowing your brain to rest.

You'll remember things because that inbox up here will then transmit memories to your hippocampus down here on the side part of the brain.

But if you can address this part of the brain, it'll work so much better going into the evening.

So the best thing you can do is go for a twenty minute walk maybe.

But if you can get a nap for 20 or 30 minutes late in the afternoon, that's a tremendous way to kind of refresh your brain.

Greg, thanks for your call.

Unforeseen I'm out of time for this evening.

If you have any questions concerning mental health issues that I can answer on the air, you may via the Internet at Matters of the Mind at Wakeboard.

>> I'm psychiatrist Jeff Offer and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube God willing on PBS willing I'll be back again next week.

>> Thanks for watching.

Goodnight